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Developmental and epileptic encephalopathy 111(DEE111)

MedGen UID:
1846991
Concept ID:
C5882690
Disease or Syndrome
Synonym: DEE111
 
Gene (location): DEPDC5 (22q12.2-12.3)
 
Monarch Initiative: MONDO:0957780
OMIM®: 620504

Definition

Developmental and epileptic encephalopathy-111 (DEE111) is an autosomal recessive severe neurologic disorder characterized by early-onset refractory seizures, global developmental delay, hypotonia, impaired gross motor development, impaired intellectual development, and absent speech. Most patients have macrocephaly. Brain imaging shows frontal, parietal, and perisylvian polymicrogyria, dysmorphic basal ganglia and corpus callosum, and hypoplastic pons. Additional features may include feeding difficulties, poor vision with ocular anomalies, congenital cardiac abnormalities, and recurrent infections associated with neutropenia. Death in early childhood may occur (Ververi et al., 2023). For a discussion of genetic heterogeneity of DEE, see 308350. [from OMIM]

Clinical features

From HPO
Cryptorchidism
MedGen UID:
8192
Concept ID:
C0010417
Congenital Abnormality
Cryptorchidism, or failure of testicular descent, is a common human congenital abnormality with a multifactorial etiology that likely reflects the involvement of endocrine, environmental, and hereditary factors. Cryptorchidism can result in infertility and increases risk for testicular tumors. Testicular descent from abdomen to scrotum occurs in 2 distinct phases: the transabdominal phase and the inguinoscrotal phase (summary by Gorlov et al., 2002).
Nephrolithiasis
MedGen UID:
98227
Concept ID:
C0392525
Disease or Syndrome
The presence of calculi (stones) in the kidneys.
Single transverse palmar crease
MedGen UID:
96108
Concept ID:
C0424731
Finding
The distal and proximal transverse palmar creases are merged into a single transverse palmar crease.
Hypertensive disorder
MedGen UID:
6969
Concept ID:
C0020538
Disease or Syndrome
The presence of chronic increased pressure in the systemic arterial system.
Sinus tachycardia
MedGen UID:
11700
Concept ID:
C0039239
Disease or Syndrome
Heart rate of greater than 100 beats per minute.
Premature ventricular contraction
MedGen UID:
56236
Concept ID:
C0151636
Disease or Syndrome
Premature ventricular contractions (PVC) or ventricular extrasystoles are premature contractions of the heart that arise in response to an impulse in the ventricles rather than the normal impulse from the sinoatrial (SA) node.
Hypoplastic left heart syndrome
MedGen UID:
57746
Concept ID:
C0152101
Disease or Syndrome
Critical congenital heart disease (CCHD) is a term that refers to a group of serious heart defects that are present from birth. These abnormalities result from problems with the formation of one or more parts of the heart during the early stages of embryonic development. CCHD prevents the heart from pumping blood effectively or reduces the amount of oxygen in the blood. As a result, organs and tissues throughout the body do not receive enough oxygen, which can lead to organ damage and life-threatening complications. Individuals with CCHD usually require surgery soon after birth.\n\nPeople with CCHD have one or more specific heart defects. The heart defects classified as CCHD include coarctation of the aorta, double-outlet right ventricle, D-transposition of the great arteries, Ebstein anomaly, hypoplastic left heart syndrome, interrupted aortic arch, pulmonary atresia with intact septum, single ventricle, total anomalous pulmonary venous connection, tetralogy of Fallot, tricuspid atresia, and truncus arteriosus.\n\nAlthough babies with CCHD may appear healthy for the first few hours or days of life, signs and symptoms soon become apparent. These can include an abnormal heart sound during a heartbeat (heart murmur), rapid breathing (tachypnea), low blood pressure (hypotension), low levels of oxygen in the blood (hypoxemia), and a blue or purple tint to the skin caused by a shortage of oxygen (cyanosis). If untreated, CCHD can lead to shock, coma, and death. However, most people with CCHD now survive past infancy due to improvements in early detection, diagnosis, and treatment.\n\nSome people with treated CCHD have few related health problems later in life. However, long-term effects of CCHD can include delayed development and reduced stamina during exercise. Adults with these heart defects have an increased risk of abnormal heart rhythms, heart failure, sudden cardiac arrest, stroke, and premature death.\n\nEach of the heart defects associated with CCHD affects the flow of blood into, out of, or through the heart. Some of the heart defects involve structures within the heart itself, such as the two lower chambers of the heart (the ventricles) or the valves that control blood flow through the heart. Others affect the structure of the large blood vessels leading into and out of the heart (including the aorta and pulmonary artery). Still others involve a combination of these structural abnormalities.
Pulmonary artery stenosis
MedGen UID:
65965
Concept ID:
C0238397
Anatomical Abnormality
An abnormal narrowing or constriction of the pulmonary artery, in the main pulmonary artery and/or in the left or right pulmonary artery branches.
Biventricular hypertrophy
MedGen UID:
807328
Concept ID:
C0281788
Disease or Syndrome
Thickening of the heart walls in both ventricles.
Feeding difficulties
MedGen UID:
65429
Concept ID:
C0232466
Finding
Impaired ability to eat related to problems gathering food and getting ready to suck, chew, or swallow it.
Low-set ears
MedGen UID:
65980
Concept ID:
C0239234
Congenital Abnormality
Upper insertion of the ear to the scalp below an imaginary horizontal line drawn between the inner canthi of the eye and extending posteriorly to the ear.
Polymicrogyria
MedGen UID:
78605
Concept ID:
C0266464
Congenital Abnormality
Polymicrogyria is a congenital malformation of the cerebral cortex characterized by abnormal cortical layering (lamination) and an excessive number of small gyri (folds).
Convulsive status epilepticus
MedGen UID:
137148
Concept ID:
C0311335
Disease or Syndrome
A type of status epilepticus characterized by a prolonged bilateral tonic-clonic seizure, or repeated bilateral tonic-clonic seizures without recovery between.
Bilateral tonic-clonic seizure
MedGen UID:
141670
Concept ID:
C0494475
Sign or Symptom
A bilateral tonic-clonic seizure is a seizure defined by a tonic (bilateral increased tone, lasting seconds to minutes) and then a clonic (bilateral sustained rhythmic jerking) phase.
Focal-onset seizure
MedGen UID:
199670
Concept ID:
C0751495
Disease or Syndrome
A focal-onset seizure is a type of seizure originating within networks limited to one hemisphere. They may be discretely localized or more widely distributed, and may originate in subcortical structures.
Severe global developmental delay
MedGen UID:
332436
Concept ID:
C1837397
Finding
A severe delay in the achievement of motor or mental milestones in the domains of development of a child.
Hypoplasia of the pons
MedGen UID:
341246
Concept ID:
C1848529
Finding
Underdevelopment of the pons.
Multifocal seizures
MedGen UID:
482664
Concept ID:
C3281034
Finding
Seizures that start from several different areas of the brain (i.e., with multiple ictal onset locations).
Infantile spasms
MedGen UID:
854616
Concept ID:
C3887898
Disease or Syndrome
Infantile spasms represent a subset of "epileptic spasms". Infantile Spasms are epileptic spasms starting in the first year of life (infancy).
Thin corpus callosum
MedGen UID:
1785336
Concept ID:
C5441562
Anatomical Abnormality
An abnormally thin corpus callous, due to atrophy, hypoplasia or agenesis. This term is intended to be used in situations where it is not known if thinning of the corpus callosum (for instance, as visualized by magnetic resonance tomography) is due to abnormal development (e.g. a leukodystrophy) or atrophy following normal development (e.g. neurodegeneration).
Inguinal hernia
MedGen UID:
6817
Concept ID:
C0019294
Finding
Protrusion of the contents of the abdominal cavity through the inguinal canal.
Umbilical hernia
MedGen UID:
9232
Concept ID:
C0019322
Anatomical Abnormality
Protrusion of abdominal contents through a defect in the abdominal wall musculature around the umbilicus. Skin and subcutaneous tissue overlie the defect.
Frontal bossing
MedGen UID:
67453
Concept ID:
C0221354
Congenital Abnormality
Bilateral bulging of the lateral frontal bone prominences with relative sparing of the midline.
Wide anterior fontanel
MedGen UID:
400926
Concept ID:
C1866134
Finding
Enlargement of the anterior fontanelle with respect to age-dependent norms.
Macrocephaly
MedGen UID:
745757
Concept ID:
C2243051
Finding
Occipitofrontal (head) circumference greater than 97th centile compared to appropriate, age matched, sex-matched normal standards. Alternatively, a apparently increased size of the cranium.
Recurrent respiratory infections
MedGen UID:
812812
Concept ID:
C3806482
Finding
An increased susceptibility to respiratory infections as manifested by a history of recurrent respiratory infections.
Sepsis
MedGen UID:
48626
Concept ID:
C0036690
Disease or Syndrome
Systemic inflammatory response to infection.
Midface retrusion
MedGen UID:
339938
Concept ID:
C1853242
Anatomical Abnormality
Posterior positions and/or vertical shortening of the infraorbital and perialar regions, or increased concavity of the face and/or reduced nasolabial angle.
Thick eyebrow
MedGen UID:
377914
Concept ID:
C1853487
Finding
Increased density/number and/or increased diameter of eyebrow hairs.
Long eyelashes
MedGen UID:
342955
Concept ID:
C1853738
Finding
Mid upper eyelash length >10 mm or increased length of the eyelashes (subjective).
Amblyopia
MedGen UID:
8009
Concept ID:
C0002418
Disease or Syndrome
Reduced visual acuity that is uncorrectable by lenses in the absence of detectable anatomic defects in the eye or visual pathways.
Hypertelorism
MedGen UID:
9373
Concept ID:
C0020534
Finding
Although hypertelorism means an excessive distance between any paired organs (e.g., the nipples), the use of the word has come to be confined to ocular hypertelorism. Hypertelorism occurs as an isolated feature and is also a feature of many syndromes, e.g., Opitz G syndrome (see 300000), Greig cephalopolysyndactyly (175700), and Noonan syndrome (163950) (summary by Cohen et al., 1995).
Horizontal nystagmus
MedGen UID:
124399
Concept ID:
C0271385
Disease or Syndrome
Nystagmus consisting of horizontal to-and-fro eye movements.
Visual impairment
MedGen UID:
777085
Concept ID:
C3665347
Finding
Visual impairment (or vision impairment) is vision loss (of a person) to such a degree as to qualify as an additional support need through a significant limitation of visual capability resulting from either disease, trauma, or congenital or degenerative conditions that cannot be corrected by conventional means, such as refractive correction, medication, or surgery.

Professional guidelines

PubMed

Zgorzalewicz M, Galas-Zgorzalewicz B
Clin Neurophysiol 2000 Dec;111(12):2150-4. doi: 10.1016/s1388-2457(00)00453-3. PMID: 11090765

Recent clinical studies

Etiology

van Arnhem MML, van den Munckhof B, Arzimanoglou A, Perucca E, Metsähonkala L, Rubboli G, Søndergaard Khinchi M, de Saint-Martin A, Klotz KA, Jacobs J, Cross JH, Garcia Morales I, Otte WM, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE; RESCUE ESES study group
Lancet Neurol 2024 Feb;23(2):147-156. Epub 2023 Dec 8 doi: 10.1016/S1474-4422(23)00409-X. PMID: 38081201
Oliver KL, Trivisano M, Mandelstam SA, De Dominicis A, Francis DI, Green TE, Muir AM, Chowdhary A, Hertzberg C, Goldhahn K, Metreau J, Prager C, Pinner J, Cardamone M, Myers KA, Leventer RJ, Lesca G, Bahlo M, Hildebrand MS, Mefford HC, Kaindl AM, Specchio N, Scheffer IE
Epilepsia 2023 May;64(5):1351-1367. Epub 2023 Mar 11 doi: 10.1111/epi.17542. PMID: 36779245Free PMC Article
Lagae L, Sullivan J, Knupp K, Laux L, Polster T, Nikanorova M, Devinsky O, Cross JH, Guerrini R, Talwar D, Miller I, Farfel G, Galer BS, Gammaitoni A, Mistry A, Morrison G, Lock M, Agarwal A, Lai WW, Ceulemans B; FAiRE DS Study Group
Lancet 2019 Dec 21;394(10216):2243-2254. Epub 2019 Dec 17 doi: 10.1016/S0140-6736(19)32500-0. PMID: 31862249
Cross JH, Guerrini R
Handb Clin Neurol 2013;111:619-26. doi: 10.1016/B978-0-444-52891-9.00064-6. PMID: 23622209
Wasterlain CG, Gloss DS, Niquet J, Wasterlain AS
Handb Clin Neurol 2013;111:427-39. doi: 10.1016/B978-0-444-52891-9.00046-4. PMID: 23622191

Diagnosis

van Arnhem MML, van den Munckhof B, Arzimanoglou A, Perucca E, Metsähonkala L, Rubboli G, Søndergaard Khinchi M, de Saint-Martin A, Klotz KA, Jacobs J, Cross JH, Garcia Morales I, Otte WM, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE; RESCUE ESES study group
Lancet Neurol 2024 Feb;23(2):147-156. Epub 2023 Dec 8 doi: 10.1016/S1474-4422(23)00409-X. PMID: 38081201
Oliver KL, Scheffer IE, Bennett MF, Grinton BE, Bahlo M, Berkovic SF
Epilepsia 2023 May;64(5):1368-1375. Epub 2023 Mar 9 doi: 10.1111/epi.17547. PMID: 36808730Free PMC Article
Bruel AL, Vitobello A, Thiffault I, Manwaring L, Willing M, Agrawal PB, Bayat A, Kitzler TM, Brownstein CA, Genetti CA, Gonzalez-Heydrich J, Jayakar P, Zyskind JW, Zhu Z, Vachet C, Wilson GR, Pruniski B, Goyette AM, Duffourd Y, Thauvin-Robinet C, Philippe C, Faivre L
Eur J Hum Genet 2022 Jan;30(1):111-116. Epub 2021 Oct 28 doi: 10.1038/s41431-021-00985-9. PMID: 34707297Free PMC Article
Cross JH, Guerrini R
Handb Clin Neurol 2013;111:619-26. doi: 10.1016/B978-0-444-52891-9.00064-6. PMID: 23622209
Staudt M
Handb Clin Neurol 2013;111:177-81. doi: 10.1016/B978-0-444-52891-9.00017-8. PMID: 23622162

Therapy

van Arnhem MML, van den Munckhof B, Arzimanoglou A, Perucca E, Metsähonkala L, Rubboli G, Søndergaard Khinchi M, de Saint-Martin A, Klotz KA, Jacobs J, Cross JH, Garcia Morales I, Otte WM, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE; RESCUE ESES study group
Lancet Neurol 2024 Feb;23(2):147-156. Epub 2023 Dec 8 doi: 10.1016/S1474-4422(23)00409-X. PMID: 38081201
Raga SV, Essajee F, Solomons R, Van Toorn R, Wilmshurst JM
Dev Med Child Neurol 2023 Apr;65(4):526-533. Epub 2022 Oct 13 doi: 10.1111/dmcn.15433. PMID: 36229895
Juliá-Palacios N, Molina-Anguita C, Sigatulina Bondarenko M, Cortès-Saladelafont E, Aparicio J, Cuadras D, Horvath G, Fons C, Artuch R, García-Cazorla À; Institut de Recerca Sant Joan de Déu Working Group
Dev Med Child Neurol 2022 Jul;64(7):915-923. Epub 2022 Jan 31 doi: 10.1111/dmcn.15140. PMID: 35833444
Schreiber JM, Tochen L, Brown M, Evans S, Ball LJ, Bumbut A, Thewamit R, Whitehead MT, Black C, Boutzoukas E, Fanto E, Suslovic W, Berl M, Hammer M, Gaillard WD
Epilepsy Res 2020 Jan;159:106261. Epub 2019 Dec 23 doi: 10.1016/j.eplepsyres.2019.106261. PMID: 31887642
Lagae L, Sullivan J, Knupp K, Laux L, Polster T, Nikanorova M, Devinsky O, Cross JH, Guerrini R, Talwar D, Miller I, Farfel G, Galer BS, Gammaitoni A, Mistry A, Morrison G, Lock M, Agarwal A, Lai WW, Ceulemans B; FAiRE DS Study Group
Lancet 2019 Dec 21;394(10216):2243-2254. Epub 2019 Dec 17 doi: 10.1016/S0140-6736(19)32500-0. PMID: 31862249

Prognosis

Scala M, Tomati V, Ferla M, Lena M, Cohen JS, Fatemi A, Brokamp E, Bican A, Phillips JA 3rd, Koziura ME, Nicouleau M, Rio M, Siquier K, Boddaert N, Musante I, Tamburro S, Baldassari S, Iacomino M, Scudieri P; Undiagnosed Diseases Network, Rosenfeld JA, Bellus G, Reed S, Al Saif H, Russo RS, Walsh MB, Cantagrel V, Crunk A, Gustincich S, Ruggiero SM, Fitzgerald MP, Helbig I, Striano P, Severino M, Salpietro V, Pedemonte N, Zara F
Am J Hum Genet 2024 Mar 7;111(3):529-543. Epub 2024 Feb 21 doi: 10.1016/j.ajhg.2024.02.001. PMID: 38387458Free PMC Article
Chalak L, Hellstrom-Westas L, Bonifacio S, Tsuchida T, Chock V, El-Dib M, Massaro AN, Garcia-Alix A; Newborn Brain Society Guidelines and Publications
Semin Fetal Neonatal Med 2021 Oct;26(5):101273. Epub 2021 Jul 28 doi: 10.1016/j.siny.2021.101273. PMID: 34393094Free PMC Article
Spagnoli C, Fusco C, Percesepe A, Leuzzi V, Pisani F
Int J Mol Sci 2021 Apr 18;22(8) doi: 10.3390/ijms22084202. PMID: 33919646Free PMC Article
Moosa AN, Wyllie E
Handb Clin Neurol 2013;111:493-510. doi: 10.1016/B978-0-444-52891-9.00053-1. PMID: 23622198
Staudt M
Handb Clin Neurol 2013;111:177-81. doi: 10.1016/B978-0-444-52891-9.00017-8. PMID: 23622162

Clinical prediction guides

Scala M, Tomati V, Ferla M, Lena M, Cohen JS, Fatemi A, Brokamp E, Bican A, Phillips JA 3rd, Koziura ME, Nicouleau M, Rio M, Siquier K, Boddaert N, Musante I, Tamburro S, Baldassari S, Iacomino M, Scudieri P; Undiagnosed Diseases Network, Rosenfeld JA, Bellus G, Reed S, Al Saif H, Russo RS, Walsh MB, Cantagrel V, Crunk A, Gustincich S, Ruggiero SM, Fitzgerald MP, Helbig I, Striano P, Severino M, Salpietro V, Pedemonte N, Zara F
Am J Hum Genet 2024 Mar 7;111(3):529-543. Epub 2024 Feb 21 doi: 10.1016/j.ajhg.2024.02.001. PMID: 38387458Free PMC Article
van Arnhem MML, van den Munckhof B, Arzimanoglou A, Perucca E, Metsähonkala L, Rubboli G, Søndergaard Khinchi M, de Saint-Martin A, Klotz KA, Jacobs J, Cross JH, Garcia Morales I, Otte WM, van Teeseling HC, Leijten FSS, Braun KPJ, Jansen FE; RESCUE ESES study group
Lancet Neurol 2024 Feb;23(2):147-156. Epub 2023 Dec 8 doi: 10.1016/S1474-4422(23)00409-X. PMID: 38081201
Chong SC, Cao Y, Fung ELW, Kleppe S, Gripp KW, Hertecant J, El-Hattab AW, Suleiman J, Clark G, von Allmen G, Rodziyevska O, Lewis RA, Rosenfeld JA, Dong J; Undiagnosed Diseases Network, Wang X, Miller MJ, Bi W, Liu P, Scaglia F
Am J Med Genet A 2023 Mar;191(3):776-785. Epub 2022 Dec 19 doi: 10.1002/ajmg.a.63074. PMID: 36537114
Lagae L, Sullivan J, Knupp K, Laux L, Polster T, Nikanorova M, Devinsky O, Cross JH, Guerrini R, Talwar D, Miller I, Farfel G, Galer BS, Gammaitoni A, Mistry A, Morrison G, Lock M, Agarwal A, Lai WW, Ceulemans B; FAiRE DS Study Group
Lancet 2019 Dec 21;394(10216):2243-2254. Epub 2019 Dec 17 doi: 10.1016/S0140-6736(19)32500-0. PMID: 31862249
Moosa AN, Wyllie E
Handb Clin Neurol 2013;111:493-510. doi: 10.1016/B978-0-444-52891-9.00053-1. PMID: 23622198

Recent systematic reviews

Spagnoli C, Fusco C, Percesepe A, Leuzzi V, Pisani F
Int J Mol Sci 2021 Apr 18;22(8) doi: 10.3390/ijms22084202. PMID: 33919646Free PMC Article
Lattanzi S, Brigo F, Cagnetti C, Trinka E, Silvestrini M
CNS Drugs 2018 Oct;32(10):905-916. doi: 10.1007/s40263-018-0558-9. PMID: 30132269

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